Professional Ethics

Professional Ethics Facing some new challenges

January 13 & 18, 2012 -- DHS

Gary R. SchoenerLicensed Psychologist

Director of Consultation & TrainingWalk-In Counseling Center

Minneapolis, Minnesota

Ethical Framework

• Beneficence – doing good; helping;

• Non-maleficence -- avoiding harm;

• Autonomy – client’s input and role

• Fidelity – consistent with what promised;

• Justice -- welfare of client vs. others (e.g. duty to warn); equitable use of resources – having a basis to proportion them

Ethical Decision-Making

• It is often not what is ethical vs. unethical, but the comparative ethicality of the options

• This involves weighing which principles are best dealt with through one option or another

• What are the likely positive vs. negative outcomes of choosing a given course of action?

Reaching Outside the Office

• The client may contact you in an emergency resulting in contact outside sessions

• You may contact the client or someone in their life in the event of fears about their welfare such as a suicide risk

• You may also intervene in cases where there is a high risk of the client harming someone else – duty to warn or protect

Some Gray Areas

• CASE 1: Protection worker has a case with severe abuse. You visit your sister and notice the family lives next door, and her kids are going over to play in the abuse house. What actions do you take?

• CASE 2: Your brother brags to you how he fooled child protection into closing a case, by threatening his wife and kids to deny the complaint. What action options are there?

Traditional Boundaries with regard to Information Access

• Client has access to information about the professional based on published biography or revelations, news items

• Professional only has access to information about client from disclosures or access granted through signed releases

Variability between staff incommunity programs

• Role – staff who are in the community with client or who spend more time with client

• Client expectations depending on role

• Do you transport the client?

• Recovery groups

• Where do you live?

• Other areas of social activity, politics

Realities of a small community

• Client lives in same building as a friend of yours – what are the issues?

• Client interacts with a member of your family, possibly without knowing the connection;

• Former client interacts with you or a friend or family

Dual or multiple relationships

• Where you have both a professional connection and some other connection;

• Typically an issue with current clients;

• The professional is expected to be alert to any potential conflict of interest or under- mining of the professional role;

• Acknowledge the issues and potential conflict and work to limit risk of trouble

Client confidentiality

• A cardinal value and duty, but there are exceptions of all sorts;

• Mandatory reporting of child abuse/neglect; vulnerable adults abuse/neglect;

• To prevent harm to a third party;

• To intervene in a situation with a suicidal client;

• A program mandate of some sort

Traditional Concepts of Communication

• Communication by traditional mail;

• Communication by phone during limited business hours; answering machines leave messages for later response;

• Phone calls private, although a message left might be saved;

• Quick response not expected or promised

Communication in today’s world

• Expectation of being able to connect at all hours, even when professional is away from office, via cell phones, texting, etc.

• Same is true for emails;

• Emails and text messages create a record;

• Emails can be misdirected or examined – need to warn people about work computers

Cell Phones & Hand-Held Devices -- Challenges

Do you have separate personal & professional phones/blackberry’s, etc? it’s a challenge to have two, but a growing number of programs are providing them Do you accept or receive calls? Is your number blocked? Will your call be accepted if you are trying to contact client? Can client get your home #?

Text Messaging

• A growing number of people do texting instead of (or in addition to) emailing;

• This is an abbreviated type of message with less information;

• This the only way to quickly reach people;

• This is the only way to reach some young people – it can be instantaneous

• Unlike a phone call, it is silent

New Hazards

• Client messaging about things during session/activity – distracted?; in group is there a breach of confidentiality?

• Cell phones can film sessions – Staff privacy rights?

• 63% under 30 drove while using hand-held phone; 30% texted

• 5,500 people in US were killed in distracted driving accidents in 2009

Social Networking Sites

Facebook -- >500 million users• 92% of SNS users are on Facebook;• 50% log in on any given day; • Facebook – “friend” vs. “deferred”?• Posts from you, friend, relative, kid

29% use MySpace; 18% Linkedin; 50 million Twitter – 13% of SNS

Personal Exposure• CASE 3: Professional has gone through a

divorce – something his/her clients don’t know – they presume he/she is married

• Some clients are working on issues of relationship fidelity, etc.

• Professional wants to sign up for a social dating site, but is worried that a client will be asked about dating them

• What options are there?

More visibility issues

• If you use a family photograph on Facebook, even with the highest privacy settings people see that photo;

• Even if you don’t show your family to the world, friends or family may show your photo or a family activity;

• 90% of US physicians are on Facebook or Linked in or some social media.

Hazards Never Imagined –which clients may also have to

face• Happy slapping – assaulting someone

while others film it (usually on cell phone)

• Sexting – sending racy photos of yourself or someone else

• Filming and/or broadcasting a party, or other event;

• Live broadcast using cell phone or camera (privacy invasion case – Tyler Clementi suicide at Rutgers – Dharun Ravi, age 19, indicted April 2011)

Hazards Never ImaginedContinued

• Fake profiles• Internet harassment – which can

lead to great distress the same as any type of bullying (1/3 to 1/2 of adolescents?);

• Fake emails & chat screen names – so one can harass secretly;

• Massive Defriending – being shut-out by groups of friends or classmates on a social networking site such as Facebook

Undressing your Facebook friends

• FalseFlesh, billed as “adult image editing software” allows you to paste someone’s face onto a nude body

Cases to lose sleep over • Draker v. Schreiber (2006, 2008) two students created My Space site with fake photos trashing Asst. Principal – she sued them and their parents;

• Megan Meier, driven to suicide by “Josh,” created by the mother of a girl she was having a dispute with;

Cases continued • Ryan Hallingan, middle school student with a learning disorder was the focus of bullying & suggestions he was gay. He hanged himself after a girl who claimed to be his friend told him publicly he was a “loser” and that she had been pretending to be just like him so she could post their conversations on line and humiliate him.

Cases continued• Ghyslain Raza, the “Star Wars Kid,” a

Canadian adolescent made a video in 2002 pretending to fight with a light saber as a school project. Another student posted it, adding music, and 900 million saw it on the web. Raza was taunted repeatedly and dropped out of school. After treatment for depression he got support, some from the internet, graduated law school, and heads a foundation for preservation.

Cases continued

• Jesse Logan, Ohio teenager, sent nude pictures of herself to her boyfriend. After they broke up he sent them to other girls who circulated them on line. She was called a slut & ridiculed and started skipping school. Jesse went public with her story via a TV interview in May 2008, but two months later hanged herself. A classic example of the dangers of sexting.

Cases continued • 4/21/11 Buffalo, NY. Police invade home with assault rifles; throw man on floor; call him a “pervert” and “pedophile” and confiscate all computers and cell phones in the house including those of his wife and daughter. He did not have a passcode on his wireless router and it was utilized by someone nearby to download pornography. This can be done by neighbor, or from a car.

Caring Bridge – sites related to illness: therapist’s illness?; posting on client’s bridge?;

Blogs -- posting responses; Sites focused on special interests

–• Client alerts you to site• You encounter client on a site• Former client alerts you to site

Other networking issues

Should you google a client?• Emergency Situation – identity

issue;• Client denies suicide history but

has prior attempts;• Reality check on claims by client;• Checking on criminal justice

history;• Screening for sex offenders

Google & Net Research

What if the client googles you? • Intern entering therapy googles

her therapist and then wonders if she’s “blown it” by doing this.

• What if they tell you? What if you suspect?

• Sites that evaluate professionals – YELP has >25 million hits a month

Google & Net Researchcontinued

What about hiring or credentialing process – do you google candidates?

What about interns or candidates for supervision? • Do you disclose this practice?• If you stumble on information?

By 2010 78% of US companies do internet searches on applicants; 86% say it influences hiring decisions


Clients may interact with each other, adding complex dynamics to service delivery;

An angry client may create a website attacking the counselor, or counseling, or the program or therapeutic approach;

“Googlegangers” – people with same name – people can be mistaken about identity;

Anything on the internet could be false



• Facebook refuses to shut rape page run by schoolboy (Sunday Telegraph,10/17/11)

• Compromise of psychological tests:– www.mindfithypnosis.com/free-mmpi2-online– www.hypnoticmp.3.com (Dr. Dobson)– Wikipedia entry on the Rorschach which shows

10 blots and reveals common responses

More Internet Research Issues

Clients & others may research medications, treatment methods, etc. on the internet. The impact varies with the accuracy of what they find.

Research has shown that searches about medications produce different results in the US vs. Canada – Canadians are sent to Wikipedia & drug company sites first

In certain circumstances there may be a good reason to do a search of a client. Steve Behnke, APA Monitor, V ol. 41, #7, July 2010

Googling a patient is not necessarily unethical – the key is that if you do it your actions should be in the patient’s best interest. Psychiatric News, Vol. 44, # 9, May 2009

Ethical analysis: Examine beneficence, non-maleficence, autonomy, fidelity, & justice issues before doing it

Professional Ethics –Uncharted Territory

Refrain from postinging patient info.

Privacy settings; monitor internet presence

Appropriate boundaries with patient interactions on internet

Separate personal & professional content on line;

Confront or report unprofessional conduct on line

Can undermine reputation & public trust

AMA Policy: Professionalism in the use of social media

Some thoughts

The internet creates a “small town” or ethnic subgroup for all of us;

With some areas of work such as criminal justice, there may be greater challenges – clientele, role of security;

Health care rating sites are likely to grow and include more therapists – healthgrades.com, vitals.com

The Battleground

Section 230 of the Communications Decency Act: internet service providers have no accountability for anon. posts;

This area of law is evolving – some suggest having contract with client;

Firms and approaches are evolving for self-defense www.medicaljustice.com

Integrity Defenders works at burying negative information w/ positive info.

The Battle Over Criticismon the Web

• Second year law student Rockstar05 founded blog Thomas M. Cooley Law School Scam

• School sought identity of Rockstar05 to sue for defamation – issue is privacy rights of internet commentators vs. plaintiffs

• This case was complicated because company that hosts blog slipped up and revealed his email address

And more self protection

Be aware of your web-presence – google yourself;

If there is false information, contact site administrator to get things changed

Should you control on-line presence by expanding it? Should you post your own www.google/com/profile?

Collegial discussion – develop standards

On line reviews

• It’s hard to know what they mean – they are not systematic;

• The data about your work or practice may be in error or outdates;

• Many times there are only a few who do a review so there can be a heavy influence of just a few ratings

Accountability vs. defamation

David McKee, Duluth, MN, neurologist sued the son of a former patient for defamation for statements made on websites alleging bad bedside manner in the treatment of his father.

Dr. McKee was called a “real tool” and alleged a callous attitude. This is not the only such case. It was dismissed. However, the negative comments were removed.

Consent and Disclosure

What ground rules will you have for a given unit, program, or practice as far as googling?

If you do google someone, will you disclose this to them?

What rules if any will you ask clients to follow as regards the internet?

Will you ask them to maintain any privacy or respect any boundaries?

Communications/Social Media Policy

• Email: Email only to arrange or modify appointments. Do not email content…..

• GPS tracking: If you have GPS tracking enabled on your mobile phone, it could reveal that you are coming to appointments.

• Rating or review sites: Info. on them is questionable; I cannot respond to them and do not need positive ratings; ask me about any concerns you have about my services.


• Text messaging: please do not use to contact me – leave phone message for time changes, etc.; email not as good but at ….

• Internet interaction: do not use wall postings or other means of communication on the internet – none are private

• Blog or Twitter: I do not follow you on either – if there are things you want to share, bring them to a session


• Friending: It is my practice to not accept contact or “friend” requests from clients on social networking sites such as Facebook or Linkedin. They can compromise privacy and also complicate our helping relationship.

• Website or Facebook Page: If you have questions, bring them in a session. Please don’t interact on the internet.


• Search Engines: I do not research my clients on Google or other search engines. There may be occasions where you will direct me to look up something related to your life or experience, and if so we can discuss it at a future meeting. If you choose to check me out on the web I would note that not all information is accurate, and would suggest that we discuss anything which you find troubling.


• Recording: Unless we have specifically discussed it, there will be no recording of our meetings or any phone conversation. All of our discussions are private.

• Records: I will maintain the records of our work together as confidential although some billing-related information may be communicated securely. Please remember that any notes you make can compromise your privacy if not carefully protected.

Challenges for Licensure Boards

Internet services -- How will these new areas of knowledge and skills be assessed for licensing purposes?

Will Boards in any way regulate the creation of internet – based services?

In New Zealand there is an elaborate website to combat depression in young people: http://www.thelowdown.co.nz

Helping Clients or Staff who areVictims of Cyberbullying

• Clarify what victim wants/needs

• Reinforce that they are not at fault

• Avoid victim-blaming by saying things like “you just need to be assertive”

• Assist them in taking any action

• Help with any underlying problems

• Assist in improving healthy relationships

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Professional Ethics